Human=war monster. How the war has changed primary medical care.

Piotr Kochan

Lessons not learnt

For thousands of years humans have killed other humans out of envy, religion, intolerance as well as territorial, sexual and economic greed, and last but not least - enjoyment.

Murdering and hurting innocents and unarmed civilians has been the entertainment of most war theatres. And it doesn't matter if these were Viking raids or the modern army warfare - the truth is - not only soldiers die. These are nowadays typically called war crimes, but as past conflicts show, only the main leaders or commanders are prosecuted, if at all. The perpetrators of these crimes, common soldiers live on, very often until old age having big families and never setting a foot in jail.

For many years now we have been celebrating the anniversary of the liberation of Auschwitz. This year's celebrations were widely covered in Jagiellonian University's Alma Mater and in a film by Towarzystwo Lekarskie Krakowskie [1, 2]. Each time, every year, there were words of warning against the history repeating itself. But to no avail.

Who/what made him do it?

Imagine you are a "well respected citizen" living in a much respected city and in general you are a good father, a committed society member and a rich man. Probably the richest man in the country. And you reside in a huge mansion. People in the other cities look up to you, know you perfectly and you are highly influential. Your family is, too. And your family members and colleagues are also rich because of you.

Then one day, you take a shotgun and kill your neighbours. You rape and murder the whole family, the parents, children, grandparents, that you once had BBQs with. You start living in their house and killing the relatives that come visiting the neighbours. On top of that, you start killing off your colleagues that you consider are somehow unloyal. In one second you lose all respect of the other cities that considered you an important figure, you lose most of the high earnings you had, you become isolated in your city, you have to watch your every move, stay in safe rooms in your house. You are alone. You become suspicious of everyone. Your family is lost.

What are the possibilities for such change of behaviour?
1. Serious psychiatric condition?
2. Narcissistic need for a name in history as a fallen genocide idol?
3. The real, "well respected citizen" is already dead. Someone is impersonating him, being steered from the shadows?
4. Very low IQ?

The first two points often coalesce. They may include serious personality deficits and mental disorders.

The third point may be valid. Most dictators when they become strong enough, look for their doubles. It may be the case here. Especially, if you consider the war effort from a business perspective. Manipulating the reports and letting us believe that it's the former "well respected citizen" running the whole show, while the shadow figure is making tremendous amounts of money on the war. In the mean time, the "well respected citizen" is long dead or had plastic surgery. Then, when the time comes to sit at the round table and negotiate peace - the double will make a perfect scapegoat.

The fourth point may be right as well. Looking at the troublesome childhood and probable beatings the "well respected citizen" has received as a child - this may have resulted in some serious trauma and health consequences. If one looks closely, his life does bear resemblance to The Career of Nicodemus Dyzma by Dołęga-Mostowicz or Being There by Kosiński. He was the right ruthless person at the right time. Not necessarily very intelligent, but definitely cunning and dodgy. On the other hand, it's hard to imagine that such an important citizen had no access to internet and was just basing his decisions on what he was presented by the intel services.

One thing does not change throughout history. Things always end badly for dictators. It's just a matter of time.

Primary medical care in Poland in the context of the war in Ukraine

After 18 years, I have decided to end my academic career at the Jagiellonian University in Cracow this year, mostly owing to professional burnout, low income and poor professional perspectives. Despite all the teaching prizes, academic achievements and honours at the university and beyond, I felt that something was missing. And I was right. I was missing the clinical medicine.

Instead of teaching, which was my main task for the past two decades, I am now a fully fledged, full-time physician working with patients on daily basis. And I came into the spotlight at the right time. At the time of great need. When all hands on deck were needed. The community where I reside has accepted around 1,000 Ukrainian war refugees. Mostly women and children.

So, right from the start of my clinical work I was treating and helping the refugees. The patients had often travelled for many days to get away from the besieged cities or war zones in Ukraine. Very often they had either lost someone in their families or left their husbands behind, defending their home country. Most, if not all women, were in terrible psychological state. Their children, cohorted in hotels and motels in Poland, immediately presented with respiratory tract infections and various G.I. tract symptoms, including diarrhoeas and vomiting. At first, the refugees were not incorporated into the Polish medical system - only later when the state started issuing temporary identification numbers everything started going more smoothly. Except, of course, for the overloaded medical system in Poland. Refugee patients often realized that their hopes for quick specialist treatment were just wishful thinking. As all Polish patients, they had to join the long queues to specialist care. And they often had very little money to pay for medicines.

The variety of medical conditions in both Polish and Ukrainian patients is really striking. From rare genetic disorders to very common pharyngitis (Figures 1-7). My daily routine at the primary care ranges from sending traumatic cuts, amputations and head trauma to the nearby trauma centre, through treating respiratory tract and emerging infections (esp. in unvaccinated individuals), helping patients with very common vertebral column pains, burns, various skin rashes to home visits and issuing death certificates. Life is never boring here and the queues of patients seem to have no end. With a population to cover of over 7,000 persons locally, it always fills up ones' medical doctor calendar.

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Figure 1. Pedunculated tumour on the foot of a patient.
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Figure 2. Trauma or melanoma? Or both?
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Figure 3. Post COVID-19 fistulated empyema.
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Figure 4. Very common find - infected pharynx and tonsils.
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Figure 5. Thermal (cold) injury of palm. Self medication of a probable HPV wart.
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Figure 6. Pedestrian hit and mauled by car. Healed fractures after trauma surgery and successful skin transplants.
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Figure 7. A refugee patient with rare Melkersson–Rosenthal syndrome.
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[1] Bielecka-Pieczka A. 77. rocznica wyzwolenia KL Auschwitz-Birkenau. Alma Mater 2022; 230:98-100.
[2] Towarzystwo Lekarskie Krakowskie. Wykłady internetowe związane z 77. rocznicą oswobodzenia niemieckiego nazistowskiego obozu koncentracyjnego Auschwitz - Birkenau (24.01.2022). Access valid on 25 May 2022: http://www.tlk.cm-uj.krakow.pl/ video/tlk_77_AuschwitzBirkenau.html

Conflict of interest: none declared

To cite this article: Kochan P. Human=war monster. How the war has changed primary medical care. World J Med Images Videos Cases 2022; 8:e18-25.

Published on: 25 May 2022

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